Active on Website - Request to be Certified for VA Benefits

Full Name

First NameLast Name

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Please be sure to keep your email and phone numbers up to date with the Registration Specialists or you may miss important information sent through the Veterans ListServ emails, or if an instructor is trying to reach you.

I plan to use:

Chapter 33 percentage (Select N/A If NOT Applicable):

If you are using Chapter 33 benefits you MUST provide us with your remaining entitlement.

*You can find this on the previous term’s last Awards Letter you should have gotten from VA, or by setting up your eBenefits Premium Account through the www.gibill.va website.

Semester:

Have you attended another college or university since you last registered at Brazosport College?

If yes, list the schools you attended. Include Name, City and State.

Will you be a guest student from another college?

If so, which college have you arranged to send us a Parent Institution email from?

Degree or Certificate Program (at BC you are requesting to be certified for this term):

If working on a degree, please select which one.

If you chose AAS, you MUST specify the exact degree plan.

If you chose BAT, please indicate which field.

If you chose AAT, please indicate which field.

If you chose a 2+2 program, please type the school name and the appropriate major.

If you are seeking a Non College Degree (NCD) certificate, which of the following are you on?

Other

Will you be applying for Tuition Assistance with National Guard, Coast Guard, or any other branch of service?

If you last drew benefits at another school, you must complete a VA Form 22-1995 available in the Certifying Official’s Office or on the www.gibill.va.gov website (key it in the Search box). If you submit it online or mail it to Muskogee, please also deliver a copy to this office so the Certifying Official can process your certification.

Do you anticipate the POSSIBILITY of any other sources paying towards your tuition and fees other than the VA?

Will you be applying for a scholarship?

If so, what kind?

Do you work for a company that will pay your tuition & fee bill by the start of school?

If so, which company?

Will they also be paying for your books or supplies?

Are you applying for any kind of departmental or co-op scholarship?

Are you aware of anything that will pay solely towards your tuition & fees besides the VA?

If so, what?

Notify the Certifying Official immediately if you become aware of any other source paying solely for tuition & fees for this semester. If the Certifying Official has to do an adjustment for anything after your initial certification to VA or finds that any other source paid SOLELY for your tuition & fees, you will be responsible for any overpayments that were made to the VA that BC has to pay back to VA and then charge you for.

I understand that I can only register for classes required on my chosen program or listed as pre-requisites for those..

I understand that I must provide a substitution letter for courses that I wish substituted.

I understand that I cannot be certified without submitting all VA required documentation.

I understand that all formal communication regarding my VA benefits will be sent to my BC email address.

I understand this form must be submitted every semester I wish to be certified. Post 9/11 students must submit at least a week prior to the Drop for Non-payment in order for arrangements to be made to hold their bills.

I understand that if my schedule changes in ANY way or if there is a change from online to on campus or viceversa, it results in a change of Tuition & Fee and I MUST notify the Veterans Service Office so proper adjustments can be made.

Signature (type your name)

Brazosport College Request to be Certified for VA Benefits